Long-term follow-up after botulinum toxin A (BTX-A) injection into the detrusor for treatment of neurogenic detrusor hyperactivity in children

Abstract

PurposeTo prove the long-term efficacy of BTX-A injection in the management of children with neurogenic detrusor hyperactivity.Materials and methods28 out of 145 children with neurogenic bladder (15 male and 13 female, mean age 10.7 years) who were treated between 2002 and 2010 and became non-responders to conservative treatment were included into the retrospective study.We injected 10-12 U/kg of BTX-A (Botox®) into the detrusor at 20-30 sites, sparing the trigone. The mean follow-up was 48 months (range 6-84 months).ResultsGroup 1. 14 patients had a single injection of BTX-A. Five of them were successful.Mean bladder reflex volume increased (from 62.9 to 117.5 ml), maximum detrusor pressure decreased (from 59 to 37.5 cm H2O), detrusor compliance increased (from 4.8 to 9.5 ml/cm H2O), and leak-point-pressure decreased (from 46.5 to 24.2 cm H2O). Four patients did not respond and were treated by ileocystoplasty. Another five were lost to follow-up. Group 2. 14 patients had repeated (mean 2.5) injections of BTX-A with a mean interval of 13.7 months. In thirteen patients, urodynamic parameters of the first and last injection were similar to those obtained in Group 1, showing a good response. One patient received an ileocystoplasty.ConclusionBTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC). The efficacy lasted a mean of 12 months and urodynamic response was unchanged even after several injections. In our series, 21.7% of children with severe low-compliance bladders were non-responders.

Outcomes of intra‐detrusor injections of botulinum toxin in patients with spina bifida: A systematic review

“…Nine studies out of 12 gave information about adverse events. There were no perioperative urinary tract infections in six studies . Three studies reported post‐injections urinary tract infections, rates ranging from 4% to 29% .…”

“…Maximum detrusor pressure (Pdetmax) was evaluated in eight of the series included and was significantly reduced in all of them . These results were observed 1 month after injection with a persistent reduction at 6 months.…”

“…Following evaluation of the full text of the remaining 15 papers, three more studies were excluded as they were overlapping series. The remaining 12 articles, published between 2002 and 2015, were included in this systematic review (n = 261 patients) and fully analyzed …”

“…The total number of injections ranged from one to six per patient . Mean interval between injections varied from 6 months to 16 months .…”

300 IU vs. 200 IU of OnabotulinumtoxinA for detrusor overactivity

“…The authors of this paper report data from a retrospective analysis done in a single center with significant experience [1, 2]. The idea behind their work is to assess the efficacy of treatment with botulinum toxin, using a significantly lower dose, in patients with neurogenic or idiopathic detrusor overactivity.…”